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General NPI Number Information
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NPI Number | 1285053918
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 3615 HIGHWAY 528 NW STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-8919
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Country | US
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Telephone | 505-899-4334
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Fax | 505-792-4236
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Provider Business Mailing Address
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Address Line | 3615 HIGHWAY 528 NW STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-8919
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Country | US
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Telephone | 505-899-4334
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Fax | 505-792-4236
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Authorized Official
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Title or Position | PATIENT SERVICES COORDINATOR
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Name | MRS. TIFFANY HAYS
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Credential |
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Telephone | 505-899-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0959
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License Number State | NM
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